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By Dr. Walter H. Gotlieb, M.D., Ph.D. April 5, 2013

Robotics: The New Frontier for Surgery

"Traditionally, we were trained believing that 'the bigger the scar the bigger the surgeon'. This paradigm has fundamentally changed and now reads 'the smaller the scar the bigger the surgeon'. Indeed, surgery was performed by laparotomy using large incisions resulting in large scars. However in recent years surgeons have gradually shifted to the minimally invasive approach resulting in shorter hospital stay, fewer complications, and better quality of life.

Robotic surgery, originally developed by NASA to perform surgeries in space stations, has found its way into the civilian operating room. It is revolutionizing access to minimally invasive surgery and patient outcome thanks to improved three dimensional high definition immersion vision and intuitive surgical dexterity with more degrees of freedom compared to the human hand.

Since its introduction at the Jewish General hospital five years ago, the results indicate major benefits of this surgical approach, with lower peri-operative complications, reduced need for pain medications, shorter hospital stay and lower real average hospital costs, as compared to traditional open surgery. In addition, the team was able to increase the proportion of patients benefiting from a minimally invasive surgical approach for certain cancers from 17%, prior to the introduction of the Da Vinci Robot, to over 95% within 2 years.

As our team began seeing the benefits of robotic surgery to patients from a clinical outcomes perspective and to the health care system from a resource utilization and cost perspective, we were emboldened to make the case for its use to patients in Quebec (the McGill University Health Centre, Université de Montréal, Université de Laval), across Canada (The University of Ottawa, St. Michael’s Hospital in Toronto, University of Alberta and Vancouver General Hospital) and internationally (China, India, Israel).

The future of robotic-assisted surgery will evolve with the further development of the  computer interface present between the surgeon and the patient, that will allow to integrate radiological images obtained prior to surgery into the surgical screen , and by exploiting real time digital analysis of the surgical field, helping the surgeon to identify structures based on differences in color or movement. Pre-operative training on computerized simulation of the surgery and added feedback loops are being developed to further increase safety ultimately benefiting the patients."

Dr. Walter H. Gotlieb, M.D., Ph.D.
Director of Surgical Oncology of McGill University
and world authority on surgical robotics technology.

jghfoundation.org

About the author

Walter H. Gotlieb completed his medical degree summa cum laude at the Université Libre de Bruxelles, in his native Belgium, where he went on to obtain board certification in Ob-Gyn.

Following two years at the National Institutes of Health, where he obtained the National Cancer Institute Award of Outstanding Performance, he performed a three year fellowship in Gyn-onc at UCLA. He was then recruited by the by Tel Aviv University, Tel Hashomer Hospital, where he co-founded and built up the Department of Gynaecologic-Oncology from 1994 to 2003.

In 2003, he was recruited by McGill University. He obtained license to practice in Europe, Israel, California, and Canada. In addition to his clinical responsibilities, he is involved in scientific research in ovarian cancer as a Project Director in the Lady Davis Research Institute and Senior Scientist of the Montreal Center for Experimental Therapeutics and Cancer. His efforts focus on translational research and novel therapeutic tools for ovarian cancer, and he has been the pioneer and driven “robotic” surgery in gynaecologic cancer in Canada. He has lectured around the world, and has proctored robotic surgery in Canada, China, India, and Israel.

A recipient of twelve national and international awards in the area of cancer research, Dr. Gotlieb is well published with over 100 peer-reviewed manuscripts in reputable international journals. Dr. Gotlieb presently sits on the executive council of the International Gynecologic Cancer Society, and is the secretary treasurer of the Gynecologic Oncology Society of Canada. He is senior editor of the International Journal of Gynecologic Cancer. His prior involvement with medical societies includes the executive council of the Israel Gynecologic Oncologists, the executive council of the Society of Gynecologic Oncologists of Canada, the SGO 2006 program committee, the International Committee of the SGO, and Vice President of the Association des Gynécologues Oncologues du Québec.

Dr. Gotlieb is presently Professor of Ob-Gyn and of Oncology at McGill University. He is the Director of Gynecologic Oncology at the Segal Cancer Center of the Jewish General Hospital,  and Director of Surgical Oncology at McGill University. He recently completed an executive course in health care management and delivery at the Harvard Business School.

Acknowledgements

Photo of Dr. Gotlieb:  courtesy of the Jewish General Hospital

Photos of the Da Vinci robotic surgery technology: courtesy of Intuitive Surgical Inc.

Dr. Gotlieb biography courtesy of the Jewish General Hospital

Dr. Gotlieb statement courtesy of Dr. Gotlieb

S.P.A.C.E. is very grateful to Maureen McIntyre of the Fine Arts Department for her initiative and commitment to this project.

Comments

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    Maureen McIntyre

    April 7, 2013

    “Very stimulating presentation…it held me fascinated and excited about the individual,social and economic benefits.Visionary advances,an exciting future…special thanks to Dr.Gotlieb for a very clear and articulate presentation…readily understood by lay people.Enriching” - .Robert Kavanagh,PhD, Academic Dean

    “The response from everyone was the same:awesome! Dr.Gotlieb was an excellent speaker - very natural and easy going.And yet,the content of his presentation was staggering.
    I certainly hope the Jewish General Hospital realizes what they have and that they do everything they can to keep him here.I certainly would choose him and robotic surgery if I ever needed this.He inspires so much confidence and clearly cares about his patients.
    Our students and teachers that attended have very much benefited from this presentation and I know that it will give us much to consider as we drive toward the future.” - Karen Gabriele,Chair, Biomedical Laboratory Technology

    “I thoroughly enjoyed his talk.He is a wonderful speaker” - Ursula Sommerer,S.P.A.C.E Liason Officer,Office of Instructional Development

    “I have heard so many wonderful comments about it throughout the day,...it was a huge success.My oldest son Jordan,attended and gave me his version of how great it was” - Barbara Freedman,Dean of Instructional Development

    ‘...an amazing talk,well attended,with lots of very positive feedback afterwards…I`ve already heard from multiple sources… students just loved it” - Andrew Katz, Professor ,Department of English & S.P.A.C.E. Co-ordinator

    “What an interesting doctor and what a super presentation - extremely informative and encouraging.” -Lois Valliant,Professor Art History,Fine Arts Department

    “...Dr.Gotlieb is definitely a visionary.I was trying to digest all the changes he has been witness to in his field…and imagining how exciting and challenging it must have been to be such a major part of the development of this revolutionary technique.What worries me is the state of the system he is working in.

    I am just hoping that far-seeing men of science,like Dr.Gotlieb,can continue to push the boundaries in this “brave new world” of `business models` and administrative bureaucracy that is increasingly bogging down progress in spheres where it isn`t the right fit…”  - Margaret Black,Dawson College Library

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    Maureen McIntyre

    April 9, 2013

    I really enjoyed it. - Louise Goldwax,invited guest

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    Maureen McIntyre

    April 11, 2013

    ...it was well-attended.He was a great speaker,the visuals were informative and entertaining and he treated his audience as intelligent…and there were consequently, numerous intelligent questions afterwards - Gabriel Sydenham,architect ,OAQ, RAIC,R.I.B.A.

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    Charles-Etienne Gouin

    April 12, 2013

    Was very cool and informative, did not expect this technology was around and it opens up a lot of possibilities for the future!

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    Ruth H

    April 12, 2013

    The presentation was extremely interesting and educational. It was great to hear about the developments in surgery that exist and are to come. He spoke clearly and intelligently, and showed some intriguing footage from the robotics.

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    Cicca

    April 12, 2013

    He was a great speaker! Very approchable. The talk was catered to a general audience, very easy to comprehend. Great eye-opener I had no idea we had access to this technology. I think it’s very important to describe procedures to the general public. We should be more educated on all the medical operations options we have. This talk was a good opportunity to get a glimpse on technology we would not normally see. This was an excellent presentation, I cannot wait for the next one!

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    NickLadd

    April 12, 2013

    It was a very interesting presentation. As an Illustration student I am not often exposed to unrelated fields like robotics. I wasn’t even aware robots like these existed or were commonly used for surgery. It was a great learning experience and a nice change of pace from the usual schedule.

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    AyH

    April 12, 2013

    Very interesting talk and well presented. I’m glad I was able to attend.

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    elenet

    November 10, 2013

    What an engaging presentation! This new technique is a new and less invasive way of doing surgery, which is simply unbelievable. Their are so many benefits of using robotic surgery over opening up the body, which Dr. Walter explains clearly while keeping the attention on the audience. This man is pushing the boundaries of surgery, which ensures an exciting future for surgery making it easier and less traumatic for the patient. Also he makes these complex robots seem simple so the general public can easily understand this new type of procedure. All around great presentation which is not only relatable and interesting, but also educational.

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    AnthonyC.

    November 27, 2013

    Simply a wonderful presentation. I loved his sense of comedy along with the seriousness of his presentation. I would have to say that my favorite part from the whole presentation was when the robot created an origami, which measured smaller than the size of a penny! It is also very exciting knowing that this kind of technology exists around the world. And the part that I found rather interesting, yet strange, is that is costs less than the traditional method. I wonder what they’ll think of next!

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    Stephen.Sayegh

    December 5, 2013

    Walter Gotlieb made an amazing presentation, he showed us the advantages to allowing robotics in our operating room one every level. Despite the tremendous costs of theses machines they are evidently very worth it! I really like the quote he ended of with, “even the dwarf sitting on the giants shoulder can see further than the Giant.”

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